The invention relates to an apparatus for introducing an intubation tube into the trachea.
The introduction of an intubation tube into the trachea is a very difficult procedure, which is very difficult to perform especially for children and when malformities are present. An intubation tube normally consists of a tube made of plastic or synthetic material, which after having been introduced into the trachea is held fixed at the end with the aid of an inflatable balloon to close off the remaining free volume of the trachea. The tube must be passed under the epiglottis and through the vocal chords. This area is only visible to a limited extent from the outside. This procedure is very difficult to perform, especially for small children and must be carried out with great care in order not to damage the mentioned body parts.
Particularly in emergencies, the tube must sometimes be placed very rapidly to allow an oxygen supply as soon as possible. The intubation in emergencies, for example with burns or poisoning of small children, must be carried out when the child is conscious, where strong resistance normally occurs.
A need for an apparatus therefore exists with which such a tube can be rapidly, precisely and reliably introduced into the trachea. It is also desirable to have the distal end of the tube constantly in view during the introduction procedure or to visually observe the insertion of this end.
It is therefore object of the present invention to provide an apparatus for introducing an intubation tube into the trachea, which allows a surgeon to insert the intubation tube in a most atraumatic manner.
The object is achieved according to the present invention with an apparatus comprising a shaft having a receptor arranged at the distal end of the shaft to which a proximal end of the intubation tube can be attached and with a coupler arranged at the proximal end of the shaft for coupling to an endoscope, a length of said shaft being variable.
The intubation tube can be reliably and securely attached to the apparatus by providing a receptor at the distal end of the shaft. This procedure can already be prepared before the actual operation, i.e. depending on the age and the size of the patient, a correspondingly suitable intubation tube can be attached to the apparatus. Normal lengths of the intubation tubes range from about 12 cm for small children to about 35 cm for adults. The provision of a coupler for attachment to an endoscope at the proximal end allows attachment of an optical instrument directly to the apparatus through which the introduction procedure can continuously be observed visually. The endoscope can be coupled so as to be an integral part of the apparatus and therefore be fixed and non-releasable.
In this case, the length of the apparatus, the length of the intubation tube and the length of the endoscope shaft are adapted to one another such that the distal end of endoscope lies precisely in the region of the distal end of the intubation tube. Both the intubation tube and the endoscope can be attached fixedly however releasably to the apparatus, so that the assembly of the three components represents a compact and narrow structure, which is simple to manipulate by the operator and at the same time provides the operator with the possibility of visually observing the introduction. The endoscope can be rigid, semi-flexible or also flexible.
After placement of the intubation tube, the endoscope can be decoupled and removed and the apparatus can also be released from the proximal end of the intubation tube, so that it can then be connected to the corresponding resuscitation devices or the like. In this configuration, the apparatus is particularly suited to be used for operative procedures by which the optimal length and sizes of the intubation tube and endoscope can be made available beforehand.
Since the length of the shaft is variable, adjustments can be made to the varying conditions during use of the same apparatus. Due to the change in length of the shaft, the connected endoscope can be achieved, i.e. in particular, the endoscope can be positioned in the region of the distal end of the repiratory tube, namely independent of the length of the intubation tube. In other words, a single such apparatus with a shaft changeable in length can be employed for different lengths of the intubation tubes, so that several apparatus need not be made available, each designed for a certain length of the intubation tube or for certain endoscopes.
This is especially helpful in emergencies, where for example only a certain intubation tube is available and correspondingly one certain endoscope, so that due to the variation in the length of the shaft, the optimal observation position for the introduction procedure can be achieved.
When anatomical anomalies are present, the endoscope can be moved back and forth due to the length variation of the shaft to achieve optimal observation conditions, so that the intubation tube can be introduced into the trachea rapidly and without trauma when such anomalies are present.
In a further embodiment of the invention, the shaft is configured to be telescopic. This configuration has the advantage that the shaft represents a narrow component despite the variability in length and that the storage space for the apparatus is relatively small. When not used, the shaft can be telescopically retracted.
In a further embodiment, the shaft is tubular. The feature has the advantage that the shaft of the endoscope can be inserted through the shaft and is surrounded by same from all sides and therefore protected. The tubular configuration of the shaft makes it possible to pass further instruments or optionally also other media such as gases or fluids through the shaft.
In a further embodiment of the invention, the shaft is configured with several telescopic tubes slideable within one another. The feature simplifies the length variability of the shaft in a constructively simple manner and at the same time the configuration as a tube allows the passage or introduction of instruments or media.
In a further embodiment of the invention, a gas connection is arranged at the proximal end of the apparatus, which communicates with the interior of the hollow shaft. The feature has the considerable advantage that live-saving oxygen can be supplied even when introducing the intubation tube, which can be decisive in saving life, especially in emergencies. In emergencies where suffocation is threatening, the operator when introducing the intubation tube is already capable of simultaneously introducing oxygen and need not wait until the tube has been placed before connecting the oxygen.
In a further embodiment of the invention, a handle is arranged at the distal end of the apparatus through which the apparatus can be manipulated. The feature has the considerable advantage that the operator can securely and fixedly hold and guide the apparatus in one hand when introducing the intubation tube with the handle, so that his other hand is free for other manipulations.
In a further embodiment of the invention, the receptor at the distal end of the shaft of the apparatus for attaching the intubation tube is configured as a muff, onto which the end of the intubation tube can be slid. The feature has the advantage that the intubation tube can be placed on the apparatus in a simple sliding procedure and correspondingly, after placement of the intubation tube, the connection can be released again.
In a further embodiment of the apparatus, the receptor is configured as a hollow muff, into which a proximal end of the intubation tube can be inserted. The feature has the advantage that a radially thin construction is achieved by the introduction of the intubation tube into the hollow muff.
In a further embodiment of the invention, the muff is configured to be slightly conical. The feature has the advantage that the intubation tube is seated fixedly in the receptor, however is still releaseable, and that a sufficient sealing surface is provided by the conical surfaces lying upon one another, so that the escape of gas being passed through the apparatus and the intubation tube is prevented.
In a further embodiment of the invention, the shaft is configured such that the endoscope shaft can be passed through the apparatus from the proximal end. The feature has the advantage that the endoscope can be introduced into the apparatus by a simple shifting procedure and the sensitive endoscope shaft is surrounded and protected by the shaft of the apparatus, so that in the end, only the optical end of the endoscope coupled thereto projects from the proximal end of the apparatus. Preferably, semi-flexible endoscopes are employed, i.e. those with an endoscope shaft capable of following the position and curvatures taken on by the intubation tube when being introduced into the trachea.
In a further embodiment of the invention, the shaft is configured such that a gas can be passed through the shaft, also when the endoscope is inserted. The feature has the advantage of multi-functionality, such that a respiratory gas can still be introduced through the shaft despite the fact that the endoscope is inserted.
In a further embodiment, the apparatus is provided with a slot along its length, through which the apparatus can be coupled to a shaft of an endoscope. The feature is of special advantage when the apparatus is to be attached to a rigid endoscope, whose shaft is bent at the distal end, a so-called intubation fiberscope. By providing the slot, the apparatus can be drawn in a radial movement onto the straight portion of the endoscope shaft, i.e. after the distal bend of the shaft, and then slid in direction of the proximal end and coupled to the endoscope. Rotary elements can be provided, which are rotated over the slot after attaching the apparatus to the endoscope shaft and thus prevent the apparatus from releasing to the side.
In a further embodiment, the apparatus can be clamped to the endoscope housing by the coupler. This very simple construction has the advantage that the apparatus can be secured to an existing conventional endoscope without any special adaptation of the endoscope in the region of the endoscope housing. To improve the clamping effect, a screw can be provided.
In a further embodiment of the invention, the coupler is configured as a locking mechanism for locking the apparatus to the endoscope or can be secured to the endoscope housing with a union nut connection.
When a locking mechanism is provided for locking the apparatus to the endoscope, it is preferred that the locking mechanism comprises at least one ball catch and at least one recess is formed in the endoscope housing for engaging the ball catch. The securement of the apparatus with a ball catch engaging in a recess on the endoscope has the particular advantage that the apparatus can be rapidly and securely fixed to the endoscope and released again just as rapidly.
It is also preferred that the recess be formed as a circumferential groove on the endoscope. The feature has the advantage that when attaching the apparatus to the endoscope, care need not be taken to provide a certain rotary orientation of the apparatus with respect to the axis of the endoscope, because the apparatus in this embodiment can be secured in any angular position with respect to the endoscope axis.
In a further embodiment, the securement of the apparatus to the endoscope housing is configured as a bayonet connection. In another embodiment of the invention, the coupler is configured to be integral with the endoscope. The feature has the advantage that the apparatus is fixedly coupled to the endoscope.
In a further embodiment of the invention, the endoscope is provided with a camera. The feature has the advantage that the operator can observe the image with both eyes and recognize the complicated anatomy and optionally anomalies and can react correspondingly so that the tube can be properly inserted and placed without trauma as far as possible.
It will be understood that the above-mentioned features and those to be discussed below are not only applicable in the given combinations, but may also be used in other combinations or taken alone without departing from the scope of the present invention.